When concerned about the possibility of skin cancer often the dermatologist can reassure the patient that the lesion is not worrisome, and save the patient the anxiety, scar and cost associated with a biopsy. However sometimes the lesion will be deemed suspicious enough to warrant a biopsy. There is both science and judgment involved in determining which lesions should or should not be biopsied. It is a skill that comes with knowledge, training and experience. A recent study has confirmed how difficult it is to avoid biopsying too much without at the same time missing something important. A study published in JAMA Dermatology found that dermatologist were on average more expert at this process than physican assistants (PAs). PAs required significantly more biopsies per melanoma discovered than dermatologists. But perhaps even more importantly, patients screened by a physician assistant were significantly less likely than those screened by a dermatologist to be diagnosed with melanoma in situ (the earliest stage of melanoma). The expert eye of a dermatologist can make a difference in saving a patient from an unnecessary biopsy and also picking up and early melanoma that might otherwise be missed.


Accuracy of Skin Cancer Diagnosis by Physician Assistants Compared With Dermatologists in a Large Health Care System
Alyce M. Anderson, PhD1; Martha Matsumoto, MD2; Melissa I. Saul, MS3; et al Aaron M. Secrest, MD, PhD4,5; Laura K. Ferris, MD, PhD2
JAMA Dermatol. Published online April 18, 2018.